tbuckley/cabot-search huggingface dataset:
Abstract P622: Increase From Low to Moderate Consumption of Caffeinated Coffee is Associated With Favorable Changes in Body Fat
Authors: Matthias Henn, Nancy Babio, Romaguera Maria, Zenaida Vázquez-Ruiz, Jadwiga Konieczna, Jesús Vioque, Laura Torres-Collado, Cristina Razquin, Pilar Buil-Cosiales, Montserrat Fitó, Helmut Schröder, Frank Hu, Itziar Abete, Maria de los Ángeles Zulet, Tania Fernández-Villa, Vicente Martín, Ramón Estruch, Josep Vidal, Indira Paz-Graniel, J. Alfredo Martínez, Jordi Salas-Salvadó, Miguel A. Martínez-González, Miguel Ruiz-Canela
Journal: Circulation (2023)

Introduction: Higher consumption of coffee and caffeine has been linked to less weight gain and lower body mass index in prospective cohort studies, usually with exposure assessment limited to baseline values. As BMI is a proxy for adiposity but does not capture fat tissue or its metabolically relevant distribution, precise measurements of distinct adipose tissues are needed, so the cardiometabolic impact of an anti-obesity effect can be assessed. Hypothesis: We assessed the hypothesis that an increase in coffee consumption is associated with a reduction in body fat, in particular with trunk fat and visceral adipose tissue (VAT). Methods: In the setting of a large, randomized trial of Mediterranean diet and physical activity intervention, we evaluated 1483 participants with metabolic syndrome. Changes in the consumption of caffeinated and decaffeinated coffee were derived from validated food frequency questionnaires at baseline, 6 months and yearly during follow-up. Fat tissue was measured with dual x-ray absorptiometry at baseline and after 6, 12 months and three years. Linear multilevel mixed effect models were used to investigate the relationship between changes in coffee consumption and corresponding concurrent changes in fat tissue over three years. Results: After adjustment for intervention group, and other potential confounders, an increase in caffeinated coffee consumption from no or infrequent consumption (≤ 3 cups/ month) to moderate consumption (1-7 cups/week) was associated with reductions in total body fat (Δ z-score: -0.06; 95 % CI: -0.11 to -0.02), trunk fat (Δ z-score: -0.07; 95 % CI: -0.12 to -0.02), and VAT (Δ z-score: -0.07; 95 % CI: -0.13 to -0.01). However, changes to even higher levels (&gt; 1 cup/day) showed no significant association. Conclusions: Moderate consumption of caffeinated coffee, but not high consumption, was associated with reductions in total body fat, trunk fat and VAT in a Mediterranean cohort with metabolic syndrome. Decaffeinated coffee was not linked to adiposity indicators. In conclusion, moderate consumption of caffeinated coffee may be part of a weight management strategy.
Abstract P400: Effectiveness and Acceptability of Dietary Telehealth Interventions Targeting Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis
Authors: Rupal Trivedi-Kapoor, Shaimaa Elshafie, Randall L Tackett, Henry N Young, Elisabeth L Sattler
Journal: Circulation (2023)

Introduction: Dietary telehealth interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic. Objective: To examine (1) effectiveness of dietary telehealth interventions in improving diet-related CVD risk factors and (2) their acceptability among CVD patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the effect of dietary telehealth interventions on CVD risk factors (Table 1) among adult CVD patients. Two investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms, and included English language RCTs published before July 2022. Pooled data for each CVD outcome were assessed using a random effects model, and mean difference (MD), standardized MD (SMD), or risk ratio (RR) were calculated using R software. Results: A total of 15 RCTs with 3,751 participants were included in the analysis. Participants had a mean age (SD) of 60.9 (3.6) years, 23.3% were women. Most RCTs were conducted in the US (33.3%) and in urban areas (93.3%). Interventions involved either phone calls, apps, texts, or websites, and follow-up durations ranged from 4 to 56 weeks. Of the 15 studies, 4 were of high quality, 10 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD: -3.01 [95% CI: -4.75 to -1.28]) and low-density lipoprotein cholesterol (SMD: -0.11 [95% CI: -0.19 to -0.03]) to significantly favor dietary telehealth interventions compared to usual care among CVD patients. There was no significant difference between the acceptability of dietary telehealth interventions and usual care. Significant I 2 indicated moderate to considerable heterogeneity. Conclusions: Dietary telehealth interventions show promise in addressing CVD risk factors.
Abstract P660: Correlates of Cardiovascular Health Among Unhoused Individuals in a Southeastern City: A Pragmatic Measurement
Authors: Anika L Hines, Margot Ackermann, Allison Auten, Sarah Collins, Kelly King Horne
Journal: Circulation (2023)

Background: Individuals experiencing homelessness have higher rates of cardiovascular disease than housed populations. Understanding cardiovascular health among unhoused individuals could inform health promoting programming and policies; however, this population is often difficult to reach and understudied. Methods: We partnered with Homeward—a regional coordinating agency for homelessness services—to assess cardiovascular health (CVH) via their semi-annual point-in-time (PIT) count. The PIT is a census of individuals experiencing homelessness in shelters and on the streets within the regional catchment on a pre-designated night. Trained staff administered a 10-minute electronic survey, which captured demographic information and cardiovascular health domains modeled after the American Heart Association’s “Life’s Essential 8”. Considering limited time and context, we used a pragmatic approach to define four behavioral health factors (sleep, food insecurity, physical activity, and smoking) and four self-reported health conditions (overweight/obesity, prediabetes/diabetes, high blood pressure, and high cholesterol). Each component earned 1 point for positive attributes (e.g., adequate sleep) or 0 for negative attributes (e.g., having high blood pressure). Components were summed to a score with a range of 0-8. We also assessed stress to create a broader measure ranging from 0-9 (with low stress earning an additional point). We performed a multivariable linear regression to understand correlates of cardiovascular health among individuals experiencing homelessness. Results: The PIT included 336 unhoused individuals currently sleeping in shelters or outdoors. The mean score for the 8-point measurement was 4.74 (SD=1.62), and the mean score for the 9-point measurement was 5.03 (SD=1.78). Neither the 8- nor 9-point score differed by gender, education, veteran status, length of homelessness, where the individual slept the night prior to the PIT count, or eviction history. In the adjusted model, increasing age was associated with a half point decrease in CVH score (β=-0.49; p =0.006). White unhoused respondents demonstrated a lower CVH score compared to Black respondents (β =-0.579; p =0.03) adjusting for other factors. Day laborers and part-time workers demonstrated approximately 1-point higher CVH scores (β =1.01; p=0.03; β =0.88; p=0.033, respectively) than unemployed individuals. Conclusion: Age, race, and employment status demonstrated associations with ideal cardiovascular health in this population of unhoused individuals in the southeastern US. Preliminary findings suggest that employment might be a target for cardiovascular health improvement among unhoused individuals.
Abstract P623: Long-Term Mortality and Causes of Death After Venous Thromboembolism: The Atherosclerosis Risk in Communities Study
Authors: Debora Kamin Mukaz, Aixin Li, Pamela L Lutsey, Neil A Zakai, Weihua Guan, Aaron R Folsom, Mary Cushman
Journal: Circulation (2023)

Background: Each year in the U.S, 60,000-100,000 people die of venous thromboembolism (VTE), but little is known about mortality and causes of death over the long-term after VTE. Hypotheses: VTE, especially cancer-related VTE, is associated with poor long-term survival. Cancer and circulatory diseases are the main causes of death after VTE. Methods: Atherosclerosis Risk in Communities (ARIC) cohort participants, free of VTE at baseline (n=15,516), were followed (1986-2019) to identify first-time VTE (classified as unprovoked, cancer-provoked, or other-provoked, e.g., after surgery) and deaths. ICD10 codes were used to define cause of death. The proportion who died for each cause of death after first VTE, by type of VTE, was tabulated. Hazard ratios (HRs) of death by type of VTE were estimated with Cox proportional hazards models adjusted for age, race, gender, and pre-baseline cancer. Survival rates were visualized by adjusted survival curves. Results: Over a maximum follow-up of 33 years, 1,076 participants had first-time VTE; 441 were unprovoked, 271 were cancer-provoked, 364 were other-provoked. Mean age at first VTE was 74. After unprovoked VTE, 37% died of circulatory diseases (excluding VTE) and 13% of cancer. Those values were 35% and 13% for other-provoked VTE. By contrast, for cancer-provoked VTE, 80% died of cancer and 10% of circulatory diseases (excluding VTE). In the Figure , those with VTE had poorer long-term survival than 14,400 participants without VTE, and cancer-provoked VTE had the highest mortality. Overall, the HR of death was 2.75 (95% CI: 2.49-3.05) for those with vs without VTE. Those with cancer-provoked VTE had the highest HR, 10.02 (95% CI 8.81-11.40), but those with unprovoked and other-provoked VTE also had higher mortality than those without VTE. Conclusions: In this study, long-term survival after VTE was poor. Apart from cancer-provoked VTE, circulatory diseases were the primary causes of death after VTE. Optimizing cardiovascular prevention could improve long-term survival of patients with VTE.
Abstract P512: Association Between Resting Rate Pressure Product and All-Cause Mortality Among United States Adults
Authors: Aayush Visaria, Seung Jae Moon, Pamela Panahon
Journal: Circulation (2023)

Background: Rate pressure product (RPP) is a measure of myocardial oxygen consumption and often used to quantify cardiac exercise workload. We sought to determine whether resting RPP was associated with all-cause mortality in healthy U.S. adults. Methods: This was a nationally representative, retrospective cohort study of the 1999-2018 National Health and Nutrition Examination Survey (NHANES), linked to the National Death Index through 2019. We included adult, non-pregnant participants without cardiovascular disease, kidney dysfunction, hypertension, diabetes, or current chronotropic agent use. RPP was calculated as the product of mean systolic BP (of 3 sitting BPs) and resting heart rate, and classified into quintiles (Q1≤7300, Q2 [Ref]: 7300-8250, Q3: 8250-9200, Q4: 9200-10400, Q5: &gt;10400). We used multivariable Cox regression to estimate risk of all-cause mortality, adjusting for demographics, CVD risk factors, and comorbidities, and accounting for the survey design. Results: Among 19,954 participants (mean age 40y; 9,653 [48%] female; 8,056 [66%] non-Hispanic White), 1,013 died over a median follow-up of 10.3 years (IQR, 5.6-15.5). Adults in Q3-Q5 had significantly increased unadjusted risk of all-cause mortality compared to Q2 (HR [95% CI], Q1: 0.89 [0.50,1.58], Q3: 1.69 [1.06,2.72], Q4: 1.97 [1.16,3.34], Q5: 2.69 [1.71,4.22]). Adjustment for covariates attenuated risks of mortality but remained 61% higher for Q5 (Q2 [Ref], Q1: 1.02 [0.77,1.36], Q3: 1.09 [0.85,1.40], Q4: 1.22 [0.93,1.59], Q5: 1.61 [1.25,2.07]). When stratifying by gender, men, but not women, demonstrated increased risk of mortality in Q4 and Q5 (Women, Q4: 0.84 [0.54,1.31], Q5: 1.33 [0.89,1.98]; Men, Q4: 1.53 [1.07,2.18], Q5: 1.79 [1.30,2.46]). Conclusion: Healthy adult participants with a resting RPP greater than 10,400 had 61% higher risk of all-cause mortality compared to a RPP less than or equal to 7,300. This effect seems to be more pronounced in men than women. Further longitudinal studies are needed to understand the independent, predictive value of RPP and factors (e.g. aerobic activity) driving RPP.
Abstract P508: Social Polarization and Parent Support for Child Physical Activity and Cardiovascular Health
Authors: Vybhavi Kotireddy, Christopher Carr, Jennifer L Gay, Junia N De Brito, Amanda Trofholz, Allan Tate, Jerica Berge
Journal: Circulation (2023)

Healthy People 2030 estimates that 3 out of 4 children (ages 6-13) do not meet guidelines for aerobic physical activity, an important contributor to cardiovascular health. Determinants of physical activity (PA) occur at individual, household, and neighborhood levels yet little is known about how geospatial risk factors (neighborhood segregation and income inequity) interact with parental influences on child PA. The current study explored the association between index of concentration of extremes (ICE) and child cardiovascular health outcomes, and whether parents PA, child PA, and parent support of child PA modified this association. Methods: A subsample of parent-child dyads from the Family Matters Phase II cohort study (n=350) participated in a multi-method follow up study including survey, geospatial (American Community Survey), and biomarker data collection in Minneapolis-St. Paul, MN (2019-2022). Parents self-reported PA, child PA and parent support of child PA, and sociodemographic characteristics (e.g., family structure, educational attainment, annual household income) via an online survey. Children attended a clinic visit to measure height, weight, pulse, and systolic [SBP] and diastolic [DBP] blood pressure. ICE, used as a measure of census tract social polarization reflecting racial segregation and tract income inequity, was operationalized in these tertiles: concentrated deprivation, middle, and concentrated privilege. Multivariable linear regressions were used to evaluate the association between ICE tertiles and child cardiovascular health indicators (SBP, DBP, pulse, and BMI percentile). Models were adjusted for parent age, education, race and ethnicity, and household income. Interaction terms between ICE and parents PA, child PA, and parent support of child PA were further explored in these models. Results: Increases in parent engagement in light- and moderate-intensity PA (~30-45-minute increments) were associated with -2.65 mmHg lower DBP (P&lt;0.001) and -2.39 mmHg lower SBP respectively (P=0.001) among children living in the least privileged tracts. The overall interaction of the relationship depended on the census tract privilege (Int. P=0.014), and there was no evidence of a favorable parent PA relationship in medium and most privileged tracts. Light parent PA and ICE interactions were consistent for child pulse and DBP (Int. P&lt;0.05). Parent limiting of screen time had favorable interaction effects for child moderate PA in medium privilege tracts but not at the extremes (Int. P=0.024). Conclusions: Interventions targeting structural disadvantages should consider multilevel components that integrate parent support and modeling of PA to address cardiovascular health disparities in pre-adolescent children. In privileged contexts, alternative interventions may need to target sedentary behaviors to improve child PA.
Abstract P641: Gaming the Way to Cardiovascular Health in Nepal: A Digital Approach in Adolescents
Authors: Dayana Shakya, Karin Flodin, Dip Raj Thapa, Jon Victor Bankler, Hua Bai, Ulf Wilhelmsson, Madhusudan Subedi, Nawi Ng, Natalia Oli, Abhinav Vaidya, Per Backlund, Alexandra Krettek
Journal: Circulation (2023)

High prevalence of behavioral risk factors for cardiovascular disease (CVD) warrants a life course approach for efficient prevention. Our previous HARDIC trial in semi-urban Nepal shows conventional CVD educational interventions for mothers improved knowledge, attitude, and practice (KAP). Digital cardiovascular health promotion provides opportunities to efficiently reach adolescents. Our aim was therefore to develop such digital health promotion through a serious game that is educational and entertaining, as an innovative way to reach adolescents. We conducted a mixed-method study to assess adolescents’ KAP and perception regarding CVD, explored opportunities for digital cardiovascular health promotion, and developed a concept for a serious game prototype. In total, 649 adolescents grades 8-10 in two government and seven private schools in a semi-urban community of Nepal were surveyed cross-sectionally following parental consent. A self-administered questionnaire assessed KAP of CVD, mobile phone use, internet availability at home and gaming behaviors. For deeper understanding of adolescents’ perception on CVD, we conducted eight focus group discussions (FGDs) separately among boys and girls (n=76). The health belief model and the technology acceptance model guided FGD development and analysis. Eighty percent of adolescents were aged 13-15 years, 49% were girls and 40.4% studied in government schools. The median (IQR) percent scores for KAP were 70.6 (10.59), 78.5 (8.46) and 69.5 (11.59), respectively. Good KAP (median percent scores &gt;75%) was found in 27.7%, 69% and 27.8% adolescents, respectively. Knowledge ( p &lt;0.001), attitude ( p =0.025) and practice ( p &lt;0.001) was higher among adolescents in private than government schools. Girls had better attitude than boys (&lt;0.001). Furthermore, 98% adolescents had smartphone access and 91.6% had internet access.Preliminary FGD analyses show that adolescents mentioned physical, nutritional, mental, environmental, and hereditary causes for CVD. Financial and work-related burdens, as well as psychological, mental and family-related issues were perceived to influence CVD severity. Temptations for junk food and physical inactivity were barriers to follow heart-healthy behavior. Adolescents perceived serious games as beneficial and easy to use for creating CVD awareness. The game should offer challenge and exhibit increased levels of difficulty to remain stimulating throughout its intended use.We conclude that the existing gaps in knowledge and practice, with good attitude and excellent mobile and internet prerequisites, provide great opportunity for serious games in Nepal. The prototype of “Happy Heart” is being pilot-tested among adolescents, suggesting a promising way forward for digital cardiovascular health promotion.
Abstract P643: Health Behaviors and Health-Related Quality of Life Among the Korean Adults Aged 18 - 64 Years
Authors: Miso Kim, Jina Choo
Journal: Circulation (2023)

Introduction: There was little information on heart-healthy behaviors, which are determined as recently updated lifestyle behavioral factors, in the associations with health-related quality of life (HRQOL) in the general population. Hypothesis: We hypothesized that either individual or combined heart-healthy behavior(s) would be significantly associated with HRQOL. Methods: A cross-sectional study was conducted using data from the 7th Korea National Health and Nutrition Examination Survey with 10,396 adults aged 19-64 years (4,412 men and 5,984 women). Seven heart-healthy behaviors were used, i.e., current non-smoking, non-binge drinking, sufficient physical activity, sufficient sedentary behavior, sufficient intake of fruits and vegetables, no-sugar-sweetened beverage intake, and sufficient sleep duration. EuroQOL-5 scores converted to 100 points (range: 0 - 100) were taken for HRQOL. The hypothesis was tested using multiple linear regression analysis with complex sampling designed to use weighted values after adjusting for age, gender, region, income, education, marital status, number of comorbidities, and the other healthy behaviors. Results: Of the participants (N = 10,396), 77.4% reported current non-smoking, 85.1% non-binge drinking, 50.4% sufficient physical activity, 54.1% sufficient sedentary behavior, 35.7% sufficient intake of fruits and vegetables, 42.2% no sugar-sweetened beverage intake, and 56.5% sufficient sleep duration. Women were significantly more likely to have higher percentages of heart-healthy behaviors than men. Among men, sufficient physical activity (p = 0.047) was significantly associated with EuroQOL-5 scores. Among women, non-sedentary behavior (p = 0.001) and sufficient intake of fruits and vegetables (p = 0.040) were significantly associated with EuroQOL-5 scores. Individuals with a greater number of heart-healthy behaviors showed significantly higher scores of EuroQOL-5 (p = 0.002) in a linear pattern among men, but not among women. The prevalence of having 0 - 2, 3 - 5, and 6 - 7 of the healthy behaviors was 12.8%, 74.4%, and 12.8%, respectively. Compared with the group with 0 - 2 of the healthy behaviors, the group with either 3 - 5 (p = 0.009) or 6 - 7 (p = 0.001) showed significantly higher scores of EuroQOL-5 among men, but not among women. Conclusions: Some individual and combined heart-Healthy behaviors were significantly associated with HRQOL; these associations differed by gender. Heart-healthy behaviors should be further emphasized and encouraged in men to elevate the levels of HRQOL, and may be paid attention in women to the efforts of identifying confounding factors in the associations between heart-healthy behaviors and HRQOL.
Abstract MP15: Mediation Effects of Social, Behavioral, and Metabolic Risk Factors on Racial Disparities in Cardiovascular Disease Mortality in US Adults
Authors: Jiang He, Joshua D Bundy, Siyi Geng, Ling Tian, Hua He, Katherine T Mills, Jing Chen
Journal: Circulation (2023)

Background: Traditional cardiovascular disease (CVD) risk factors contribute to racial disparities in CVD mortality. However, there are scarce data on the role of social determinants in these disparities. Methods: A nationally representative sample of 50,808 individuals aged ≥20 years from NHANES 1999-2018 were included in the analysis. Data on social, behavioral, and metabolic factors were collected in each NHANES survey. CVD deaths were ascertained from linkage to the National Death Index with follow-up through 2019. Multiple mediation analysis was used to simultaneously investigate the contribution of each risk factor to racial differences in CVD mortality. Results: Over an average 9.4 years of follow-up, 2,589 CVD deaths were confirmed. Age- and sex-adjusted CVD mortality rates (95% CI) per 100,000 were 380.1 (334.0, 437.3) in White, 479.6 (393.3, 592.5) in Black, 288.2 (214.1, 397.8) in Hispanic, and 251.2 (140.9, 502.8) in other racial/ethnic populations. After adjusting for all risk factors in the table, individuals who were unemployed, had a low family income, did not own a home, were not married or living with a partner, were a current smoker, reported no leisure time physical activity, slept &lt;6 hours or &gt;8 hours per day, had obesity, hypertension, diabetes, or hypercholesterolemia, or had an albumin-to-creatinine ratio ≥30 mg/g or estimated glomerular filtration rate &lt;60 ml/min/1.73 m 2 were at significantly higher risk for CVD mortality. After adjusting for the above risk factors, the hazard ratio (95% CI) for the Black-White difference in CVD mortality decreased from 1.54 (1.34, 1.77) to 0.86 (0.75, 1.00). Family income, not being married or living with a partner, not owning a home, and unemployment explained 24.8%, 20.8%, 14.5%, and 12.8% of Black-White differences in CVD mortality, respectively. Conclusion: Social determinants of health play an important role in racial disparities in CVD mortality. These findings call for public health interventions beyond lifestyle changes and medical treatment.